Therapeutic Practice in Schools

Working with the Child Within: A Clinical Workbook for Counsellors, Psychotherapists and Arts Therapists

Lyn French, Reva Klein, Lyn French, Reva Klein

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136653308
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

This book is an indispensable guide to providing therapy services for children and adolescents in primary and secondary school settings. The contributors have extensive experience in the field and carefully examine every aspect of the work, ranging from developing an understanding of the school context in all its complexity, through to what to say and do in challenging therapy sessions and in meetings with school staff or parents and carers.

Therapeutic Practice in Schools opens with an overview of key psychoanalytic concepts informing therapy practice. This is followed by a detailed exploration of the hopes and anxieties raised by providing therapy in schools, the factors that either enable or impede the therapist's work and how to manage expectations as well as measure outcomes. The practical aspects of delivering therapy sessions are also covered, from the initial assessment phase through recognising and working with anxieties, defences, transference and counter-transference to working with endings. An awareness of the impact of social identity, gender, race and culture on both the therapist and client is woveninto the book and is also discussed in depth in a dedicated chapter.

The manual offers a comprehensive yet highly readable guide to the complex world of school-based therapy. It provides practical examples of how therapists translate theory into everyday language that can be understood by their young clients, ensuring that trainees starting a placement in schools, as well as therapists beginning work in the educational setting for the first time, are able to take up their role with confidence.

Part I

Key psychoanalytic
concepts as applied to
work with children and
adolescents

Chapter 1

Theoretical framework

Sue Kegerreis

Why do we need theory?

All school therapists need theoretical underpinning for their work. This sounds like an obvious and unnecessary statement, but it needs to be given thought. It could be argued that the key elements in a good school therapist are the capacity to connect well with children and to offer a well-intentioned, supportive presence. Some might fear that too much theory could get between the child and us. It is true that all of us can use theory as something to hide behind, or as a way of avoiding our own vulnerability and anxiety in encounters with our clients. There is a danger that we might impose our theories on the children, seeing them as embodiments of what we have learned about, rather than as the unique and necessarily puzzling individuals they are. We might see what we expect to see and ‘understand’ what we expect to find. Most importantly, if the theory is in the front of our minds and too much the focus of our interest, then we could avoid a real meeting with the child; the encounter is then rendered at best sterile and at worst provocative or unhelpful.

However, we all have theories, about how the children’s difficulties began, or about how we could intervene in a helpful way. We cannot operate at all if we have no underlying idea about what is wrong or what might make a difference. Even without any training or specific orientation, there will be theories in our intellectual arsenal. Moreover, our capacity to connect with the emotional reality of the child and thereafter to offer helpful interventions will be affected by the quality of the theories we are using. Theory is a means to make our perceptions clearer, our connections more meaningful and a way of enabling us to get closer to the child in all his complexity.

What is even more powerful is the role theory can have in making us more resilient, as it makes the children we work with more comprehensible to us. It enables us to better manage their impact on us and to continue working with them when things get difficult. Theory can give us tools to decipher what is going on, to process how the children affect us, and to use all the experiences they give us to enable us to become more finely tuned to them, equipping us to offer them something usable and useful. It can stop us prematurely foreclosing on our ability to offer something to them and it can stop us from simply reacting or even retaliating because we do not understand.

This says something about how theory needs to be situated; it needs to sit at the back of our mind rather than in the front, allowing us to be fully present in each session, but there as a resource to call on to inform our thinking and help us steer ourselves and our work more accurately.

What is particular about the psychodynamic
perspective?

Psychodynamic therapy in schools has its theoretical roots in psychoanalytic child psychotherapy, which itself is an adaptation of psychoanalysis. There are many ways of trying to describe the core elements of this approach, so although the ideas I have chosen to illustrate it here are indeed central, they constitute only one possible constellation of key concepts. I will focus on the unconscious, the importance of early experience and the use of the relationship in the therapy room. These will provide a foundation for the potential exploration of more complex and subtle thinking in the vast and ever-growing literature. Psychoanalysis is the rootstock for the theory, but grafted onto it are many other layers of understanding as psychodynamic practitioners explore their field and extend their thinking through learning from their clients.

The unconscious

The first and most fundamental principle behind all psychoanalytic and psycho-dynamic thinking is that all human beings have an unconscious, which is hugely influential in shaping our perceptions, our relationships and our responses to experience. We are able to make conscious choices, of course, but are heavily influenced in everything we do, say and feel by elements of which we have no conscious awareness. We are only intermittently and partially in touch with all that motivates us; what is more, we are only intermittently and partially aware of our true feelings at any given time.

This has many levels. On a level relatively close to consciousness, we may be aware of one kind of thought or feeling, but are breathtakingly capable of deceiving ourselves about what we think and feel, in ways that can seriously lead us astray. We may hide with contempt or critical responses the fact that we are envious or scared; we can hide our need for others in spurious superiority; or we can get angry when we are feeling loss or hurt deep down. We can pretend that we don’t want something when really we fear it is out of reach or we are not worthy of it. Brearley has spoken eloquently on this kind of self-deception (2010). We can simplify what we see and feel, as in idealising someone or seeing them as simply bad, in order to avoid conflict and ambivalence.

At a deeper level, our perceptions, relationships and choices are fundamentally affected in an ongoing way by patterns that have been established in our minds. We do not see things as they are, whatever that may mean; our vision is distorted by a complex amalgam of what we have made of our experiences and our emotional state then and now. We can be compelled, despite our best conscious intentions, to repeat patterns. We may find ourselves in similar relationships with partners: being disappointed in the same ways or being abused or neglected just like before; or we might repeatedly find ourselves, for example, overburdened and taken for granted at home or in work, find ourselves with a contemptuous boss, or outshone by a colleague. These are not just unhappy coincidences; they are the result of unconscious dynamics that lead us to seek out and create repetitions of emotionally familiar situations in which we construct well-known, even if hated, situations and relationships.

Or we may deceive ourselves about where a feeling belongs. For example, when Jan (17) is anxious about her boyfriend’s loyalty and becomes jealous and intrusive she may be hiding from herself the awareness that she is having doubts about him or fantasies about another relationship. When Kemal (14) is feeling hostile and critical of those around him, what he may experience consciously is that people are being hostile and critical towards him. This may of course be grounded in reality; but even if not, he may experience this because he is attributing to others a feeling or quality that is being disowned in himself. One of the clearest examples of this dynamic (in psychoanalytic terms known as projection) was humorously portrayed in the late 1990s BBC sitcom The Royle Family. Denise was always palming off the care of her child onto others out of supreme laziness. Yet her brother Anthony, who was far more conscientious and helpful both to himself and others, was the one labelled lazy a great deal of the time. In fact Denise would complain indignantly if he hesitated for a moment when asked to look after little Dave – ‘Anthony, he’s your only nephew!’ – missing entirely any awareness of her own laziness and neglect of her only son. By projecting her laziness onto Anthony, she attributed to him what she failed to notice or do anything about in respect to herself.

As mentioned, patterns of relating have been laid down by our previous experiences and get repeated. Mariam (13), who has been rejected at home, finds herself over and over again acting in such a way as to make it likely she will continue to be rejected, despite the fact that this is the last thing she apparently wants. Milo (10), who has felt it was his job to keep his mum going, will find himself repeatedly in that supportive role at school or with other adults, despite his wish to be with adults who do not require this of him. Our unconscious manifests itself in all aspects of our lives, from the largest-scale of our experiences – the jobs we are in, the roles we play, the partnerships we establish or fail to establish – to the smallest: the pictures we draw, the tunes we hum absent-mindedly, the books or films we like and dislike, what we forget, how we dress and the way we fiddle with our pens.

What this means is that the unconscious roots of our characters and behaviours are not only immediate responses to the present, but in many cases can be tracked back to their origins in our earlier experiences. This takes us on to the second of the key ideas I am putting forward as a fundamental theoretical foundation.

The importance of early experience

This second related key idea is the fundamental importance of early experiences. What is most powerfully at work in our unconscious is laid down in our first days, weeks and months. Certainly the first three years of life are crucial in creating templates that then have the power to give shape to all that comes later, for both good and ill (Karr-Morse and Wiley 1999; J. Klein 1987; M. Klein 1959). Our characters are forged out of the unique combination of what we bring in ourselves (of which more later) and the environment into which we are born and that surrounds us as we start out in life. Good experiences later in life can repair early damage just as trauma can challenge those who have had a good start, but the early foundations have great power to affect how we experience and behave throughout our lives.

Babies are born only partly ‘made’ – the key ingredients are there but there is a long way to go before they take the shape they will have for the rest of their lives. Recent neurological research has brought new awareness of the unique plasticity of the human brain and of the way in which our long dependency period in early childhood provides us with experiences that radically affect the neurological and hormonal systems that govern our cognitive and emotional responses to the world (Schore 2002, 2003; Gerhardt 2004; Music 2010). We may each be born with differences in our capacity to manage frustration or to engage readily with the outside world as well as in such physical factors as our ease of digestion or of gaining physical control of our bodies. But major elements – such as our capacity to regulate our own emotional responses or our ability to resist being overwhelmed by stress and anxiety – have their origins in how we are treated and the extent to which we are helped to manage the vicissitudes of being very small and helpless.

We start out with our genetic heritage but are also much affected by our pre-birth environment and experiences (Piontelli 1992) and the actual events of our birth (Waddell 2002). Furthermore the circumstances of our conception, the experience our parents had of the pregnancy and of the process of delivery have considerable impact on how we are welcomed into the world, even before we have had a chance to bring our own contribution into the mix. Once we are born, an utterly unique process of interaction begins; each of us will have our own impact on those caring for us and the emotional environment in which we find ourselves. The complex tapestry of relationships that surrounds us, that shapes, colours and flavours our personal world, has an enormous influence on how we experience and relate to what life brings, both to our significant others and, underlying and behind all of this, to ourselves. This consists of more than just how we are treated: each family in subtle ways creates its unique emotional repertoire and atmosphere.

It needs to be stressed that this is a two-way process as, in the other direction, each of us has our own impact on those caring for us. It is never the case that a ‘blank page’ of an infant is passively imprinted on by his parents and family. Some babies can by their temperament and nature bring out the best in their mothers, helping them find the strength in themselves and building their self-esteem. Others can bring out the worst, tapping into their mothers’ anxieties and undermining their capacity to feel nurturing and capable. Each nursing couple is different and a mother who could do well with one baby might not do so well with another.

A mother who is secure in herself and well supported will react in a particular way if paired with a baby who has an uncomfortable start and cannot easily cope with being outside in the world. She will, most of the time, be able to remain patient when he is hard to comfort or difficult to feed, gently helping him develop resources to cope with his new and alien environment, offering a calm and understanding response to his anxieties without experiencing him too much as a judgement or a punishment. She will be able to tune in to his feelings and give his experiences meaning. In contrast, a mother who is insecure and unhappy for whatever reason may easily be tipped into a vicious circle of persecutory feelings, experiencing herself as hopeless in the face of the baby’s difficulties and therefore rapidly running out of resources to cope with his physical demands – let alone connect with his feelings or offer him helpful meaning-making.

The same mother, if blessed with a baby who is ready to meet the world and is endowed with a lust for life, ease of digestion and a forgiving temperament, may find that he brings out the best in her and puts in motion some major reparative emotional dynamics, reassuring her of her creativity and goodness. But even the most well-adjusted and generously supported mother may find herself unable to cope with a particularly difficult or rejecting baby.

Beyond these very early dynamics, the family of each child creates a unique environment that will for ever shape him in a multitude of ways, exerting its force on his character and relationships and open up an emotional repertoire that is particular to them. The family will greatly affect the child’s capacity to be in touch with reality, to face and manage pain and difficulty in his life, to be curious and to learn, to love, to play, to be creative and to have a constructive part in his own and others’ lives. If he has attuned, attentive parents who can relate to his individual self and give him a sense of security, of being valued and of having a viable future, he indeed will have been dealt a good hand. If life goes relatively smoothly, with few significant losses or major disruptions, he has a chance of establishing internal stability and a self-esteem not threatened by the experience of being left or mistreated.

Many, of course, do not get these inestimable gifts and have to find a way of dealing with the world despite traumatic disruptions with their ensuing insecurities, anxieties about their own capacity to contribute to the world or to have fulfilling relationships. They are often increasingly trapped in patterns of relating that owe more to their need to defend themselves against vulnerability. They create barriers to development, learning and intimacy, provoking hostility in others and setting in motion vicious circles that stack the odds against their managing to make the most of their abilities and the resources around them.

By the time children get to school, many of these key patterns have become strongly established. Their capacity to make good use of education has been deeply affected by how they feel about being a vulnerable child, which has direct links to the vulnerability involved in being a learner. Their ability to relate constructively to teachers has been laid down by the experiences they have had so far of being dependent on adults (Youell 2006; Salzberger-Wittenberg 1983). Furthermore other elements vital to their capacity to function well in school will already have been either enhanced or jeopardised by the way they have been helped in their early years or bombarded with unmanageable impingements. They will have evolved a particular relationship with their own minds, for example, in their capacity to be curious, to entertain and play with thoughts, to be in touch with or intolerant of their inner processes. Their ability to know about and manage their own feelings will already be profoundly shaped by their experiences, as will their capacity to manage setbacks and frustrations.

So when a child is referred to the psychodynamic therapist, this theoretical background is there to help. The therapist is attuned to pick up how this child is functioning...